Dr. Robert Belshe traveled throughout rural Missouri and Illinois last year
to discuss flu vaccines during the H1N1 scare. Drug companies Merck & Co. Inc.
and GlaxoSmithKline helped pick up the tab.

Belshe, head of Saint Louis University’s Center for Vaccine Development, spoke
at more than 20 educational forums on behalf of the drug companies, and he was
paid roughly $18,000 in speaker’s fees and travel expenses, according to the
companies’ financial disclosures.

“Companies come to me because I have a deep background in vaccines and because
of my training,” Belshe said. “And if I’m available, they compensate me for
that.”

Belshe has lots of company. Dr. David Alpers, a gastroenterologist at Washington
University School of Medicine, received $134,688 from GlaxoSmithKline in
compensatory fees last year, according to company filings. Dr. David Weinstein,
an OB/GYN at Missouri Baptist, was paid more than $103,000 — $31,000 from
Glaxo-SmithKline and $72,500 from Eli Lilly and Co. — in fees, according to
filings.

Those three doctors were among 186 health-care professionals, medical
institutions and medical practices in St. Louis to receive compensation last
year from Merck, GlaxoSmithKline, Eli Lilly and Pfizer Inc. Disclosures show the
186 entities received a combined $2.5 million for participating in continuing
education on products, leading forums and for travel expenses.

The actual total for the year is likely much higher. Eli Lilly’s data covers
only the first nine months of 2009, while England-based GlaxoSmithKline’s info
covers the final nine months. Merck and Pfizer released data for only the final
six months of 2009.

As drug manufacturers prepare to increase transparency as mandated by provisions
of the health reform law, critics question whether this kind of compensation
unduly influences the practice of medicine.

While drug manufacturers disclose some payments to health-care physicians, Eric
Campbell, an associate professor at Mass General Hospital’s Institute for Health
Policy, noted that the disclosures did not contain full-year data, were
difficult to access and were unaudited.

As of right now, “there is no universal disclosure for what companies pay,”
Campbell said. “And a couple of the companies are doing it for marketing
off-label drugs.”

Both GlaxoSmithKline and Pfizer were required to disclose payments to
health-care professionals to settle investigations into the alleged illegal
promotion of drugs for off-label uses, or uses not approved by the FDA.

Belshe said speaking at forums sponsored by drug companies not only gave
continuing education on new drugs to rural physicians, it also provided
community feedback on the challenges of providing effective health care, such as
vaccinating children in rural communities.

“(Universities) want to encourage faculty with very deep expertise to provide
this type of education for community doctors, because you will get quality info
with the least amount of bias possible,” Belshe said.

Mass General’s Campbell said compensatory payments to physicians for
non-research services, such as speaking at forums or leading continuing
education seminars on particular products, were “essentially marketing-related
relationships.”

“I’m highly skeptical of calling anything of what drug companies do ‘educating.’
They sell drugs to satisfy a fiduciary duty to shareholders,” Campbell said.
“The companies hide a lot of drug sales under the rubric of education, but the
people employed on their behalf are not educators; they’re people selling
drugs.”

A 2009 report published by the Institute of Medicine of the National Academies
found that general practitioners involved in industry-sponsored studies
increased their use of the trial sponsor’s drugs. The report was compiled by the
institute’s committee on conflicts of interest in medical research, education
and practice. “Some clinical trials in community practices may be ‘seeding’
trials that (drug) companies design to change prescribing habits rather than to
gather scientifically useful information,” the report stated.

“The payments do what they’re supposed to do, which is make the doctors
prescribe the company’s drugs,” Campbell said.

“The reality is that big pharmaceutical companies do wonderful things with
medicine, and new products are developed through these companies being good
stewards but also effective business people,” said Dr. Robert Heaney, senior
associate dean of Saint Louis University School of Medicine and assistant vice
president for the university’s Medical Center. SLU received almost $12,000 from
Pfizer for clinical research last year, according to the drug manufacturer’s
filings.

For SLU, drug companies are major benefactors of ongoing research, according to
Heaney. “Merck is the primary manufacturer of vaccines. How could you not talk
to them and still be a good vaccine center?” Heaney said.

SLU enforces policies to limit the interactions of practicing physicians and
medical students with drug companies to avoid undue influence. “We have to
understand that (drug companies’) business ethics are not always compatible with
a physician’s professional ethics,” Heaney said.

Washington University and its medical school, which collectively were paid more
than $131,000 by Eli Lilly and Pfizer in 2009, said the money was part of about
$61 million in funding for research from private sources. Joni Westerhouse,
executive director for medical communications at Washington University School of
Medicine, said the university also saw a “need to ensure that corporations’
research support and business-development activities do not unduly influence
research and medical decision-making.”

“The school will continue to nurture academic-industry collaboration in medical
discovery and scientific advancement, and continue to refine and update our
policies to ensure the highest standards of ethical and professional behavior
and research integrity,” she said. The university has a five-year, $25 million
agreement with Pfizer to collaborate on biomedical research.